Endovascular Arterial Treatment
Angioplasty & Stenting
Minimally invasive treatment to improve blood flow through narrowed or blocked arteries, particularly in patients with peripheral arterial disease affecting the lower limbs.
Restoring blood flow without open bypass surgery where appropriate
Angioplasty uses a balloon to widen a narrowed artery. A stent may be used in selected circumstances to support the treated segment.
Understanding Angioplasty
Opening a narrowed artery from within
Peripheral arterial disease can cause narrowing or blockage of the arteries supplying blood to the legs and feet. When circulation is significantly reduced, revascularisation may be considered.
Angioplasty is an endovascular procedure. A fine wire and catheter are passed through the arterial system to the narrowed or blocked segment.
A balloon is then inflated across the diseased area to improve the diameter of the artery and restore blood flow. A stent may sometimes be required, depending on the artery, lesion and result of angioplasty.
Revascularisation may be considered for
- Lifestyle-limiting intermittent claudication
- Severe reduction in lower-limb blood flow
- Ischaemic rest pain
- Non-healing foot or leg wounds
- Diabetic foot disease associated with poor circulation
- Chronic limb-threatening ischaemia
Endovascular Revascularisation
How angioplasty works
The procedure treats arterial disease through the blood vessels rather than through a surgical bypass incision.
Arterial Access
The arterial system is accessed through a small puncture, commonly in the groin or another suitable artery.
Guidewire Passage
A guidewire and catheter are navigated to the narrowed or blocked segment of artery.
Balloon Angioplasty
A balloon is expanded within the diseased artery to widen the channel for blood flow.
Final Assessment
Imaging is used to assess the result and determine whether further treatment is required.
When Treatment Is Considered
Not every arterial narrowing requires intervention
Treatment decisions depend on symptoms, severity of disease, imaging findings, overall cardiovascular health and the effect of reduced circulation on the limb.
For intermittent claudication, exercise therapy, cardiovascular risk reduction and medical treatment form an important part of management. Revascularisation is considered when symptoms remain significantly limiting and imaging confirms a suitable lesion.
In patients with rest pain, tissue loss or threatened limb viability, restoring blood flow may become more urgent.
Factors considered before intervention
- Severity of symptoms
- Walking limitation
- Rest pain or tissue loss
- Arterial anatomy
- Location and length of the blockage
- Previous vascular procedures
- Other medical conditions
- Suitability for angioplasty or bypass
Before Revascularisation
Imaging defines the arterial problem
Treatment planning starts with clinical assessment of the circulation and the severity of symptoms.
Duplex ultrasound is commonly used as first-line imaging when lower-limb revascularisation is being considered. Further imaging such as CT angiography or MR angiography may be required to define the anatomy in more detail.
Clinical Assessment
Symptoms, walking distance, wounds, pulses and limb perfusion are assessed.
Non-Invasive Testing
Pressure measurements and duplex ultrasound help assess the location and severity of disease.
Detailed Imaging
CT or MR angiography may be used when further anatomical detail is required.
Complex Arterial Disease
Additional endovascular techniques
Some arterial lesions are heavily calcified or technically complex and may require additional endovascular techniques.
Balloon Angioplasty
Balloons of different designs and sizes may be selected according to the artery and lesion being treated.
Intravascular Lithotripsy
In selected heavily calcified lesions, intravascular lithotripsy may be used to modify calcium and facilitate arterial treatment.
Stent Placement
Stents may be used where appropriate according to the anatomy, arterial segment and response to angioplasty.
Angioplasty or bypass?
Both endovascular and open surgical techniques are important in modern vascular care. The choice depends on the pattern of arterial disease and individual clinical circumstances.
Individual Treatment Planning
The least invasive option is not automatically the best option
Angioplasty can offer an effective minimally invasive route to restoring circulation in many patients, but bypass surgery may provide a more appropriate solution for certain patterns of disease.
Factors such as the length and location of arterial blockage, previous procedures, available vein for bypass, other medical conditions and the clinical urgency all contribute to the decision.
After Treatment
Recovery after angioplasty
Recovery depends on the complexity of the procedure, the site of arterial access and the reason for treatment.
The access site is monitored after the procedure and circulation to the treated limb is reassessed.
Medication and cardiovascular risk management remain important after successful revascularisation because angioplasty treats a particular arterial narrowing rather than the underlying tendency to atherosclerosis.
Follow-up may include
- Review of the arterial access site
- Assessment of limb circulation
- Medication review
- Cardiovascular risk-factor management
- Wound follow-up where relevant
- Duplex surveillance in selected cases
Treatment Considerations
Benefits and risks are considered individually
Angioplasty and stenting are established endovascular procedures, but complications can occur and are discussed before treatment.
Bleeding & Bruising
Bruising or bleeding can occur at the arterial access site.
Arterial Injury
The treated artery can occasionally be damaged during endovascular intervention.
Arterial Occlusion
A treated artery can rarely become blocked during or after a procedure, requiring further treatment.
Embolisation
Material within the artery can occasionally travel further down the circulation and affect smaller vessels.
Contrast & Kidney Effects
Contrast imaging can require additional precautions in people with impaired kidney function or previous reactions.
Re-Narrowing
The treated artery can narrow again over time, and further intervention may sometimes be required.
Lower-Limb Revascularisation
Open and endovascular arterial expertise
Mr Shanka Benaragama is a Consultant Vascular and Endovascular Surgeon at Royal Free London and University College London Hospitals.
His specialist practice includes lower-limb revascularisation and peripheral arterial disease, using both endovascular and open surgical techniques where appropriate.
Peripheral arterial procedures include
- Lower-limb angioplasty
- Arterial stenting
- Intravascular lithotripsy
- Complex lower-limb revascularisation
- Lower-limb bypass surgery
- Diabetic foot and limb-preservation care
Urgent Arterial Symptoms
Sudden loss of blood flow to a limb is an emergency
Seek urgent hospital assessment for a leg or foot that suddenly becomes severely painful, cold, pale, numb, weak or markedly different from the other side. Do not wait for a routine private consultation if symptoms suggest an acute loss of circulation.
Frequently Asked Questions
Angioplasty & stenting questions
What is angioplasty?
Angioplasty is a minimally invasive procedure in which a balloon is expanded inside a narrowed artery to improve blood flow.
What is a stent?
A stent is a small scaffold placed inside an artery to help support the treated segment. Not every angioplasty requires a stent.
Does everyone with peripheral arterial disease need angioplasty?
No. Many patients are managed with exercise, cardiovascular risk reduction and medication. Revascularisation is considered when symptoms, limb risk and imaging findings justify intervention.
How is suitability for angioplasty assessed?
Clinical assessment is combined with vascular imaging. Duplex ultrasound is commonly used first, with CT or MR angiography used when further detail is required.
Is angioplasty better than bypass surgery?
Neither option is automatically better for every patient. The choice depends on the pattern of arterial disease, symptoms, clinical risk, previous procedures and individual anatomy.
Can angioplasty help a diabetic foot ulcer heal?
If poor arterial blood supply is contributing to impaired healing, revascularisation may form part of a multidisciplinary limb-preservation treatment plan.
What is intravascular lithotripsy?
Intravascular lithotripsy is an endovascular technique that may be used in selected heavily calcified arterial lesions to help modify calcium before or during treatment.
Can an artery narrow again after angioplasty?
Yes. Re-narrowing can occur over time, which is why ongoing cardiovascular risk management and appropriate follow-up remain important.
Arterial Revascularisation Consultation
Request a specialist vascular consultation
If you have peripheral arterial disease, reduced circulation to the leg or foot, or have been advised that angioplasty, stenting or bypass may be required, please contact the practice for a specialist vascular opinion.
Email to Request a Consultation → benaragama.admin@lips.org.uk